Psychology of Aggression

From this point of view, it is essential to be acquainted with existing approaches dealing with possible reasons for patient aggression[1] There are basic models taking into account patient variables, environmental factors and deficits within staff-patient interaction, that can serve to create a better understanding of it.

Internal model, according to which aggression results from mental illness, the age or gender of the aggressor. So, a variety of mental illnesses are associated the incidence in health care, as well as drug abuse. In this model, the potential patient aggressor is commonly a young male patient, with a previous history of violence and drug or alcohol abuse.

External model: It highlights the impact of environmental factors upon the cause of aggression. Some reports refer to factors such as limited space, overcrowding, hospital shifts or insufficient patient information which contribute to increasing aggressive potential of patients in a hospital or other areas of medical care. In this model, gender and age don´t play such a significant role, because the incidence relates mostly to local conditions. 

Situational model: Regarding the problem of aggression and violence in health care and their impact on relationships between staff and patients, it tries to merge both internal and external factors. But sometimes, a clear distinction between external and internal factors is difficult in a lot of incidents. Nevertheless, the research of the heterogenous basis with combined interacting variants of violence causes shall be extended[2].

A two-factor model of aggression

There are other different models dealing with understanding of causes of violence, with concepts of reinforcement, anticipated rewards and possible violence triggers. An important model is for example a two-factor model of aggression[3], developed from psychological theory and research and offering a scientific approach to the issue of violence and aggression. In this behavioural model, hostile aggression and instrumental aggression are investigated: hostile aggression is motivated by feelings of anger with intent to cause pain – a fight in a bar with a stranger is an example of hostile aggression - in contrast, instrumental aggression is motivated by achieving a goal and does not necessarily involve intent to cause pain.[4]

This terminology may vary, for example Kool uses instead of “hostile” aggression “emotional” or “affective” aggression[5] but the principle is the same: instrumental aggression seems to be more cognitively controlled as compared to emotional aggression since the action is directed by the goal to achieve something. On the contrary, emotional aggression arises because of anger, hostility, frustration and focuses on harming the target. 

It is also important to separate both of these kinds of aggressive behaviour from assertive behaviour the evaluation of which depends very often on conventional forms in the concrete society – for example: an assertive behaviour of a woman may be considered aggressive, whereas the same behaviour of a male individual as assertive.

But what about its origin? Is aggression biologically programmed or is it learned? To be able to answer these questions three different theories were developed: biological, drive and social learning.[6]